Blog Posts

Ray Iannaccone

Earlier this year, EmCare’s Executive Team launched a “road trip” initiative to better connect with providers in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.

Located in the greater West Palm Beach area amid gated communities and polo grounds, Palms West Hospital is a vibrant, growing facility that serves patients across the economic scale.

Because the hospital is near bustling coastal resorts and a stone’s throw from working farms, EmCare’s emergency department teams at the site – one focused on adult patients and second dedicated pediatric team in an adjacent unit – see everything from equestrian falls to migrant worker injuries to a spike in the winter when northerners descend on the area for a reprieve from colder temperatures.

Despite being in a beautiful and balmy location, John Halpern, DO, chairman of the Emergency Department, admits that recruiting quality physicians has been a struggle, as there are competing hospitals vying for the same candidates. This challenge is one of the reasons why Dr. Halpern asked EmCare’s President, Ray Iannaccone, MD, FACEP, FACHE, to visit his site.

“I think it’s important that the company’s executives hear from the ground troops – the men and women providing care in our EDs,” explained Dr. Halpern. “It’s a new step for EmCare, and I wanted our team to be able to get more engaged with the company.”

But this meeting wasn’t the first time that Dr. Halpern had met EmCare’s president; When Dr. Iannaccone was an emergency medicine intern in the U.S. Navy, Dr. Halpern was his attending physician at Portsmouth Naval Medical Center. It’s a small world, indeed.

The visit provided an opportunity for the company’s administration to better understand the culture at Palms West and brainstorm ways to capitalize on the facility’s advantages for clinicians. These discussions included Erika Vazquez-Cuffe, MD, medical director of pediatric emergency medicine; Venkat Kalidindi, MD, executive vice president; Michael Davis, FACHE, division client administrator; Palms West CEO Eric Goldman, and several Palms West emergency physicians and advanced practice providers.

While Dr. Vazquez-Cuffe has only been at the helm of the pediatric ED since November 2015, she and her team have been able to make significant progress in improving key clinical metrics.

“Palms West is in a great area and it has strong relationships with local emergency medicine residency programs, which is a plus,” Dr. Iannaccone said. “Its pediatric services are a real differentiator in the market, and I’m proud of how EmCare has been able to partner with the hospital to grow that offering.”

The hospital, which sees about 140 ED visits a day, chiefly serves young families and affluent adults. It doesn’t see a high percentage of seniors in the off-season, but during the winter, the senior population in the area can spike significantly.

A key topic of discussion was the facility’s sepsis initiatives and how the team plans to meet national guidelines. And, like most EDs, Palms West relies on referrals to grow its volume, so EMS outreach also was discussed.

“We sat down and had a heart-to-heart talk about the challenges and opportunities that we have here,” Dr. Halpern said. “Several clinicians had specific questions for Ray, and he committed to looking into their concerns. It was a positive meeting and I’m glad that I reached out to him.”

After touring the facility and speaking with the hospital’s administrators, Dr. Iannaccone and several clinicians had a dinner meeting at a local restaurant to continue their discussions.

“They have a good team at Palms West, and we’re going to work together to find ways to recruit more residency and fellowship-trained physicians and continue to improve outcomes,” Dr. Iannaccone explained. “Our clinicians now know that the Executive Team cares and that we’re listening, and we’re here to help.”

“It was great to meet Dr. Iannaccone,” Dr. Vazquez-Cuffe. “We feel privileged that he has taken time from his busy schedule to show us his support. We feel confident that he supports the growth and betterment of our staff.”

Visit EmCare's Facebook page for more photos from Palms West! And, if you would like to suggest your site for a future visit, please contact ray@emcare.com.

Those who have worked with me a while know that I’m a business book junkie. I don’t get a lot of free time, but when I do, I’m usually reading the latest business best seller. In fact, I’ve purchased cases of books and given them out to executives to ensure that we’re all on the same page – both literally and figuratively.

A few of you have asked me which books are my favorites, so here’s a quick top 5.

“Good to Great: Why Some Companies Make the Leap...And Others Don't” by Jim Collins - Although not all the great companies have stood the test of time (Circuit City), Collins applies a rigorous method to identify companies that have made systematic changes that turned their organizations into ones that produce positive results over the long haul.

“Jack: Straight from the Gut” by Jack Welch - Arguably the greatest manager of the century, Welch shares his story and that of GE, with insights into many of the great business processes that people take for granted now.

EmCare’s President Ray Iannaccone, MD, FACEP, FACHE, recently launched a “road trip” initiative to better connect with physicians in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.

Timing is everything. When Joni Claville, MD, ran into EmCare’s President Ray Iannaccone, MD, in the hallway at the company’s Annual Leadership Conference in Las Vegas, she took a chance and invited him to visit Terrebonne General Medical Center, where she is assistant medical director of the emergency department.

“He seemed very approachable,” Dr. Claville explained. “During his presentation at the conference, he talked about his vision for EmCare, and how he wanted to get more physicians engaged at all levels. When I saw him, I knew I had to tell him about the great things that we were doing at Terrebonne.”

“Our executive team’s first priority is connecting more with our clinicians in the field,” Dr. Iannaccone explained. “We know that it’s impossible to do that from our offices, so I’ve challenged our team to find ways to meet and really engage in meaningful conversations with our employees. We won’t know what’s working and what isn’t if we don’t listen to the men and women who are on the frontlines delivering care every day.”

Dr. Iannaccone had a trip to New Orleans scheduled, and said he and several members of EmCare’s executive team would gladly stop at the Houma, La.-based hospital.

Dr. Claville, Owen Grossman, MD, the Site Medical Director of the ED at Terrebonne General; Michael Isabelle, MD, Regional Medical Director, and several members of the medical center’s administration, including CEO Phyllis Peoples and Vice President of Physician Practice Partners, Sid Hutchinson, met with Dr. Iannaccone; David Marks, EmCare’s Chief Operating Officer, and Terry Meadows, MD, Chief Executive Officer of EmCare’s South Division. They toured the facility and got to see the day-to-day operations in the emergency department.

“It was an intimate meeting. Everyone got a chance to get to know one another, and it was a great opportunity for us to discuss what was working and where we could work together to improve and grow,” said Dr. Claville.

“It was very impressive to hear about all of the forward-looking initiatives going on at the hospital and in the community,” said Dr. Iannaccone. In 2014, Forbes ranked Houma as one of the fastest growing small cities in the United States. Nevertheless, with Houma being a small metropolis with a comparable physician base, “The environment created at Terrebonne General keeps people connected and interested. They are doing it right,” said Dr. Iannaconne.

A Track Record of Success

When Terrebonne General’s ED leadership set a goal of increasing Press Ganey survey scores for ED Physician-Patient Perception Measures for “Overall Communication with Providers,” it was a collaborative effort between EmCare and the medical center to meet the metric.

EmCare sponsored patient perception communication workshops, customized for Terrebonne, which focused on best practices to improve the patient experience, including:

Teach Back, a method to confirm patient and caregiver understanding of the course of treatment and follow-up care

Outstanding leadership and participation

Coaching techniques for improving patient communication and the use of AIDET®, the Studer Group® communication tactic

The initiative netted positive results: ED Physician-Patient Perception Measures improved by 60 percent from the first quarter to the fourth quarter of 2015.

A continuation of this collaborative spirit, the visit was more than just a meet and greet among executives, especially for Dr. Claville, who’s been with EmCare since residency.

“This meeting solidified how I feel about this organization,” explained Dr. Claville. “It was like talking to a group of friends. They really wanted to hear what we had to say and provided solid feedback. They made us feel like we were important. That’s great for a small facility like ours that can get lost in a large organization with much bigger clients.”

Dr. Claville admits that when she completed her residency, she was very reluctant to join a large national physician practice. However, when she toured a few EmCare facilities and spoke with emergency medicine leaders within the organization, she said she felt like the company could offer the right balance of national opportunities and localized support.

“Although the company is large and growing exponentially, it still has its fingers on the pulse of the people – its employees,” she said. “That was and still is important to me and to my staff.”
Regarding the impact that Dr. Iannaccone’s visit had on the facility, Dr. Claville said that the conversations that day helped “plant the seeds” for further growth and collaboration between the organizations – a “win-win for everyone.”

Check back for the next installment of On the Road with Ray! And, if you would like to request that Dr. Iannaccone visit your site, please contact ray@emcare.com.

As an election year with the White House still up for grabs, 2016 will likely be less than predictable. However, for Ray Iannaccone, MD, FACEP, FACHE, EmCare’s president, trends in healthcare are a bit easier to predict than the fate of the Oval Office.

The healthcare industry will continue to consolidate. As a result of the Affordable Care Act (ACA), Dr. Iannaccone says hospitals, systems, payors and physician groups will continue to merge to be more financially stable By the end of 2015, Levin Associates predicts the industry will have seen more than 1,312 M&As, surpassing the number of deals in 2014, which had been a landmark year for activity – until now.

The number of employed physicians will rise. Physicians will continue to abandon private practice by joining large physician groups, small local groups or hospitals, predicts Dr. Iannaccone. The need for information technology upgrades, data analysis reporting and relationship building, coupled with the growing need for compassionate end-of-life care, will continue to place stress on private practitioners who often lack the resources necessary to deliver these services. In fact, more than 200,000 physicians in the U.S. are employed, and 75% of medical residents plan to begin their careers as employees of a medical group, hospital or faculty plan, according to the Medscape Employed Doctors Report 2014.

Providers will continue to strive to move the needle on quality. Clinicians and hospitals will continue to pursue solutions to providing higher quality care with increased efficiency. Dr. Iannaccone said that key to this effort will be team-based care, where physicians, nurses, advanced practice providers, technicians, therapists, scribes and other practitioners work together to deliver care.

Expect to see more investment in information technology. “Hospitals and physician practices have been saddled over the last five years with the burden of implementing EMRs, but those investments did little to improve quality and they hurt efficiency,” explains Dr. Iannaccone. “With Meaningful Use in the rearview mirror, providers will invest in ways to modify, enhance and integrate information technology to truly affect change.” A recent report by PriceWaterhouseCoopers, “Medical Cost Trend: Behind the Numbers 2016,” confirms Dr. Iannaccone’s predictions.

Physician engagement will enable new physicians to better commit to work-life balance. “Engagement” may be the latest addition to your department’s buzzwords, but it’s a term that’s here to stay. Defined by Merriam-Webster as “emotional involvement or commitment,” an organization must strive to engage its physicians and non-clinical staff. Only in this way will they be positioned to deliver quality results and compete for the best providers, according to Dr. Iannaccone. “Our workforce is changing. Millennials want to have a say in how care is delivered and policies are developed – and all clinicians should,” explained Dr. Iannaccone. EmCare has taken significant steps to improve the ability of its physicians to contribute to the practice and have input on policies. As a physician-led organization, with Dr. Iannaccone in the president’s role, it recently developed the EmCare Partners Group (EPG) division, which seeks to create a practice culture akin to a physician partnership. "Through our EPG division, we’re piloting ways to provide greater opportunities for clinicians to contribute to the direction of the division in particular and EmCare’s clinical practice in a broader sense,” said Dr. Iannaccone. “I’m excited to see how we can integrate the ‘principles of partnership’ throughout the organization.”

And regarding the election in November, Dr. Iannaccone doesn’t see a repeal of the ACA as a possibility: “The ACA may be imperfect, but our country and our healthcare facilities have invested too much time and too many resources to turn back now. Provisions of the act, however, will continue to be tweaked to more accurately reflect what healthcare is, should be and can be for Americans.”

Ray Iannaccone, MD, FACEP, FACHE, President, joined EmCare when it joined forces with Emergency Medical Associates (EMA) in 2015. Dr. Iannaccone had been the President and CEO of EMA since 2008.